Percorrer por autor "Teixeira, Joana Ferreira"
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- Incidence and delirium risk factors in burn patients: A prospective cohort studyPublication . Silva, Márcia Pereira; Vala, Joana; Sousa, João; Teixeira, Joana Ferreira; Henriques, HelgaBackground Delirium is a neurocognitive syndrome caused by systemic disturbances, leading to impaired attention, awareness, and/or cognition. It poses a significant risk of comorbidities, mortality, prolonged hospitalization, and increased healthcare costs. The challenges in delirium management, follow-up, and rehabilitation, arising from complex chronic conditions and long-term complications after severe burns, highlight the urgent need for more research in this area. Thus, this study aims to investigate the incidence of delirium and the risk factors specific to this population. Methods This analytical observational prospective cohort study was conducted between August 2022 and January 2024. Adults (18 years and older) admitted to a single burn unit with a confirmed burn injury were included, regardless of burn severity. Sociodemographic and clinical variables included age, sex, extent of burn, and prior health status. Delirium assessment was made using the CAM-ICU scale at least twice a day. The primary outcome was the incidence of delirium and its risk factors, with secondary outcomes including the onset and duration of delirium episodes. Results/Discussion The sample consisted of 50 patients, with a delirium incidence of 52 %. Burn patients admitted to the burn unit developed delirium an average of 11.81 days (95 % CI=7.09–16.52) after hospitalization, with an average duration of 11.5 days (95 % CI = 7.28–15.72). Age was the only predisposing risk factor that emerged (p = 0.0141). Five variables emerged as precipitating risk factors in bivariate analyses: total surface burn area (TSBA) (p = 0.026), surgery (p = 0.0438), mechanical ventilation (p < 0.001), opioid infusion use (p < 0.001), and infection (p < 0.001). However, in multivariate Cox regression analyses, only mechanical ventilation remained statistically significant as a risk factor for delirium (HR=8.017; 95 % CI = 1.926 – 33.368; p = 0.004). Conclusion This study highlights mechanical ventilation as a critical risk factor contributing to the high incidence of delirium among burn patients. Early identification and management of risk factors—mainly mechanical ventilation, but also TSBA, surgery, opioid infusion use, and infection—can guide targeted interventions to improve patient outcomes and mitigate the impact of delirium on recovery.
- Specialized nursing intervention on critically ill patient in the prevention of intubation-associated pneumonia: an integrative literature reviewPublication . Almeida, Daniela Fradinho; Pinto, Maria do Rosário; Durao, Maria Candida; Henriques, Helga Rafael; Teixeira, Joana FerreiraHealthcare-associated infections are adverse events that affect people in critical condition, especially when hospitalized in an intensive care unit. The most prevalent is intubation-associated pneumonia (IAP), a nursing-care-sensitive area. This review aims to identify and analyze nursing interventions for preventing IAP. An integrative literature review was done using the Medline, CINAHL, Scopus and PubMed databases. After checking the eligibility of the studies and using Rayyan software, ten final documents were obtained for extraction and analysis. The results obtained suggest that the nursing interventions identified for the prevention of IAP are elevating the headboard to 30º; washing the teeth, mouth and mucous membranes with a toothbrush and then instilling chlorohexidine 0.12%-0.2% every 8/8 hr; monitoring the cuff pressure of the endotracheal tube (ETT) between 20-30 mm Hg; daily assessment of the need for sedation and ventilatory weaning and the use of ETT with drainage of subglottic secretions. The multimodal nursing interventions identified enable health gains to be made in preventing or reducing IAP. This area is sensitive to nursing care, positively impacting the patient, family, and organizations. Future research is suggested into the effectiveness of chlorohexidine compared to other oral hygiene products, as well as studies into the mortality rate associated with IAP, with and without ETT for subglottic aspiration.
- Targeted temperature management to minimise secondary brain injury after cardiac arrest: A systematic reviewPublication . Seixas, Joana Costa; Oliveira, Mariana; Monteiro, Mariana; Pinto, Maria do Rosário; Durão, Cândida; Teixeira, Gisela; Henriques, Helga Rafael; Teixeira, Joana FerreiraBackground: A patient recovering from an in-hospital or out-of-hospital cardiac arrest (CA) requires interventions for recovery, particularly for minimising secondary brain injury. Targeted temperature management (TTM) is the intervention with the greatest impact on neurological recovery. Aim: The aim of this systematic review was to describe current TTM in adult CA patients and its impact on functional outcomes. Methods: This systematic review was developed between March and May 2024 according to the Joanna Briggs Institute guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for reporting. Eligibility criteria were established. We systematically reviewed studies enrolling adult CA patients who received TTM and reported functional outcomes. The search strategy was applied in the following databases: Medline and CINAHL Ultimate, the Cochrane Central Register of Controlled Trials, through EBSCO, and Scopus. The Rayyan software was used for the final extraction and selection. Results: The studies retrieved highlight the following interventions for neuroprotection: the use of a continuous temperature feedback system (continuous temperature monitoring with vesical, oesophageal, or parenthetic probes) for temperature induction; conducting a preinduction time between 390 min (6.5 h) and 12 h and an induction time greater than 440 min (7.3 h); setting the target temperature between 32 °C and 37.5 °C according to the patient's characteristics for a maintenance period between 24 and 48 h; the administration of sedatives, antipyretics, and neuromuscular blockers; and the assessment of neurological prognosis only after the rewarming phase, using scales such as the Cerebral Performance Category and the Modified Rankin Score. Conclusions: Continuous research and investment in this area of knowledge are highly encouraged, particularly in terms of refining accurate neurological prognostic tools and assessment scales.